Kins connects with your insurance company in an automated way (or sometimes via phone). We use your DOB, member ID, name and insurance company to get your benefits which can include Copay, deductible, co-insurance, and more. From your benefits data we estimate your out of pocket amount and charge your credit card this amount for your appointment and we bill your insurance company the remainder.
The key point is that your out of pocket amount is an estimate, and that amount may change overtime. Therefore, we may issue a refund or a bill if we under or over estimated.
For example,
We may “overcharge” you because we were unaware of the August 10th medical bill. We will then issue a refund once our insurance company completes the transaction (can be up to 90 days later).
Since insurance companies are complex and may not provide us with the most-up-to-date data we may also undercharge you. If this were to happen we would issue a bill once your insurance completes the transaction.
This is the total amount you must pay out-of-pocket before your insurance starts to pay. For example, if your deductible is $1,000, then your insurance won't pay anything until you have paid $1,000 for services subject to the deductible. Furthermore, even after you've met your deductible, you may still owe a co-insurance for each visit.
This type of out-of-pocket payment is calculated as a percent of the total allowed amount for a particular service. In other words, it's your share of the total cost. For example, let's say:
In this situation, you'd pay $20 at the point of service. The insurance company would then pay the rest of the allowed amount for that visit. Keep in mind that the coinsurance amount may vary from visit to visit depending on what services you receive.
This is a fixed amount that you must pay for a covered service, as defined by your health plan. Copays usually vary for different plans and types of services. Typically, you must pay this amount at the time of service. Again, copay amounts are fixed-which means you will always pay the same amount, regardless of visit length. In most cases, copayments go toward your deductible.
The Kins billing team will submit the initial authorization request to your insurance company. Your insurance company will review the request to determine the number of visits allowed per care plan. Keep in mind: if you’re approved, a prior authorization only lasts for a set period of time and can expire. In most cases, additional authorization in most cases can be obtained.
Medicare only pays 80% of the cost of care, so many Medicare beneficiaries seek secondary insurances to pay the other 20%.
Medicare Part B patients without secondary insurance are responsible for a 20% coinsurance, which typically amounts to $25 per visit.I
f you have original Medicare as your primary insurance, but you also have a secondary insurance, the secondary payer becomes responsible for the 20%. In some cases, the secondary insurance also charges a copay, coinsurance, or deductible. We recommend contacting your secondary insurance carrier to find out.
If we contract with your insurance company, we are obligated to honor that contract-which means we must bill your insurance for services rendered. Some contracts also prohibit us from providing discounts or waiving patient financial responsibility (e.g., copays or coinsurances). That said, if we do not contract with your insurance, or if you have exhausted your benefits for the year, then you may be eligible to receive services on a cash-pay (i.e., self-pay) basis. Please review our self pay options with our customer service representatives.
Your health is our number-one priority. As such, we are happy to arrange a payment plan that works with your budget. That way, you can pay for your care over a time frame that works for you. Simply ask to speak to our office/billing manager.
If your insurance plan requires you to obtain a referral before seeing a specialist (e.g., a physical therapist), and you fail to do so, the insurance company may deny coverage for services rendered.
If you have not yet met your Medicare deductible, then you will pay per visit. We charge coinsurances as a dollar amount equal to the percentage. So, if you have a 20% coinsurance, you'll pay 20% of total cost, which may vary depending on services provided; if you have a 10% coinsurance, you'll pay 10% of total cost, depending on the services you receive.
Conversely, if we find that you have overpaid, we will refund you as soon as possible. As for copays-these amounts rarely vary, so if your copay for physical therapy visits is $25, you will owe $25 at each visit.
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